Identification with the SocialWork Profession: The Impact of Education.

The aim of this study is to examine how education affects students' identification with the social work profession. In particular, we examine the impact of students' experiences of their interactions with teachers, peers and supervisors at placement. A longitudinal design is applied. Data were collected from students during their first and third (final) year in social work education from seven universities and university colleges in Norway, representing a sample (panel) of 390 students. To evaluate the degree of students' identification with the profession, comparisons with student nurses are conducted. The analyses indicate (i) that students' dedication to and identification with the social work profession are largely established at a very early stage of education and (ii) that education has a positive impact on students' identification with the social work profession. At the end of their social work education, students who experience support and feedback from teachers and have confidence in their supervisors' competence express a higher degree of identification with the social work profession.

Nurses' perceptions of patient participation in hemodialysis treatment.

The aim of this study is to explore how nurses perceive patient participations of patients over 75 years old undergoing hemodialysis treatment in dialysis units, and of their next of kin. Ten nurses told stories about what happened in the dialysis units. These stories were analyzed with critical discourse analysis. Three discursive practices are found: (1) the nurses' power and control; (2) sharing power with the patient; and (3) transferring power to the next of kin. The first and the predominant discursive practice can be explained with an ideology of paternalism, in which the nurses used biomedical explanations and the ethical principle of benefice to justify their actions. The second can be explained with an ideology of participation, in which the nurses used ethical narratives as a way to let the patients participate in the treatment. The third seemed to involve autonomous decision-making and the ethical principle of autonomy for the next of kin in the difficult end-of-life decisions.

The next of kin of older people undergoing haemodialysis: a discursive perspective on perceptions of participation.

AIM: This paper is a report of a study conducted to explore how the family members of older people who will undergo haemodialysis treatment for the rest of their lives perceive participation. BACKGROUND: The rights of families to participate in treatment and health care are supported by international law, and by national law in Norway since 1999. METHOD: This study, which employed an explorative qualitative approach, was carried out in Norway in 2008. Data were derived from transcribed interviews with seven family members underwent critical discourse analysis. FINDINGS: Three discourse practices about the next of kin perception of participation were found: (1) to care and take control, (2) to struggle for involvement, and (3) to be forgotten and powerless. The next of kin said that they had no dialogue with the healthcare team, and some fought to be included in the decision-making process. CONCLUSION: The dominant part of the discourse as expressed by the next of kin seems to be a paternalistic ideology. Thus, finding ways to enable the next of kin to participate in the decision-making process seems to be a major challenge for the healthcare team in the dialysis units.

Perceptions of patient participation amongst elderly patients with end-stage renal disease in a dialysis unit.

AIM: A patient's right to influence treatment and health care has been guaranteed by Norwegian law since 1999. The aim of this study was to explore how elderly patients with end-stage renal disease who are undergoing treatment with haemodialysis for the rest of their lives perceive patient participation in a dialysis unit. METHODS: This study, which was inspired by critical discourse analysis, drew on data derived from transcribed interviews with 11 patients. FINDINGS: Two discourses related to patient participation were identified. The first and dominant discourse was called the health-care team's power and dominance. Both environmental conditions and the team's practice exercised power and control over the patients. The patients trusted the health-care team, but some felt powerless and were afraid of what might happen if they refused to follow the instructions. The health-care team owned the knowledge and decided what the patients needed to know. Most of all the patients wanted dialogue about the future. After years of treatment, patient identity seemed to be threatened by this situation. The second discourse is called the patients struggling for shared decision-making. Some patients struggled to be involved in decision-making about 'dry weight', diet, blood access and time of treatment when these factors threatened their well-being and the quality of their daily lives. CONCLUSIONS: The elderly patients' right to participate in their haemodialysis treatment did not seem to be well incorporated into the social practices of haemodialysis units. Changing the social practices in the dialysis units from a paternalistic ideology to an ideology of participation will require consideration of the context, the dialogue and the process of shared decision-making with the patient.